T Nation

Seems I'll Need TRT

Hello again. Most of you know me.
Long story short - I’ve been trying to optimize my testosterone and well being in many different ways not wanting to commit to TRT, but seems soon I’ll not have a choice. The thing that troubles me more is I’ve run a seamen analysis last week and its not perfect. The doctor said I’m still fertile, but I have lowered percentage of motile sperm and its classified as asthenozoospermia. This is the analysis:

Why I would need TRT? Well I have ALL symptoms of Low T and the following blood work(will post only most relevant of it):

06.03.2019

TSH S 1.73 µIU/ml 0.27 - 4.20 ECLIA
LH S 2.65 IU/L 1.70 - 8.60 ECLIA
FSH S 1.13 IU/L 1.5 - 12.40 ECLIA
Prolactin S 352.6 mIU/L 84.80 - 318 ECLIA
Estradiol S 16.04 ng/L 7.63 - 42.60 ECLIA
Total Testosterone S 14.14 nmol/l 9.90 - 27.80 ECLIA
Free Testosteron S 9.1 ng/l 8.30 - 40.10 RIA
DHEA-s S 8.63 µmol/l 4.34 - 12.20 ECLIA
SHBG S 32.09 nmol/l 18.30 - 54.10 ECLIA

25-OH-Vitamin D S 41.35 ng/ml > 30 ECLIA

I’ve been discovered last summer to have thyroid node, non-cancerous and this winter empty sella syndrom on the pituitary after doing NMRi. After this blood work on 23-rd April I did a consultation with Defy. They advised me to start taking cabergoline 0.125mg 2 times a week and clomid 12.5mg EOD. I could not handle how I felt from the clomid and stopped it only 10 days after. However, it has started to raise my numbers.

I took little blood tests after:

07.05.2019 - after 10 days taking caber and clomid

Prolactin S 283.5 mIU/L 84.80 - 318 ECLIA
Estradiol S 21.92 ng/L 7.63 - 42.60 ECLIA
Total Testosterone S 18.15 nmol/l 9.90 - 27.80 ECLIA

On this date basically I stopped the clomid.

11.06.2019

Free T3 (fT3) S 2.88 ng/l 2 - 4.40 ECLIA
LH S 3.09 IU/L 1.70 - 8.60 ECLIA
Prolactin S 288.9 mIU/L 84.80 - 318 ECLIA
Total Testosterone S 21.25 nmol/l 9.90 - 27.80 ECLIA
Estradiol S 21.45 ng/L 7,63 - 42,60 ECLIA
SHBG S 41.84 nmol/l 18,30 - 54,10 ECLIA
Cortisol (morning) S 480.9 nmol/l 133 - 537 ECLIA
Reverse T3 S 325 pg/ml 90 - 215 RIA
Free Testosteron S 16 ng/L 7 - 22,70 EIA

Seems the testosterone has increased. Unfortunately it turns out to be from the clomid. This is the highest T value I’ve ever measured(around 600 in the USA units) and I’ve been doing regular tests since spring of 2017.

Yesterday I run this tests:

TSH S 1.74 µIU/ml 0.27 - 4.20 ECLIA
Free Т4 (fT4) S 14.66 ng/l 9.30 - 17 ECLIA
Free T3 (fT3) S 2.79 ng/l 2 - 4.40 ECLIA
Reverse T3 S pg/ml 90 - 215 RIA
ТАТ (Tg Ат) S 10 IU/ml 0 - 115 ECLIA
A-TPO (MAT) S 5 IU/ml 0 - 34 ECLIA
Total Testosterone S 18.06 nmol/l 9.90 - 27.80 ECLIA
Free Testosteron S ng/L 7 - 22.70 EIA
SHBG S nmol/l 18.30 - 54.10 ECLIA
LH S 4.54 IU/L 1.70 - 8.60 ECLIA
FSH S 1.39 IU/L 1.5 - 12.40 ECLIA
Prolactin S 265.4 mIU/L 84.80 - 318 ECLIA
Estradiol S 27.07 ng/L 7.63 - 42.60 ECLIA
DHEA-s S 9.01 µmol/l 4.34 - 12.20 ECLIA
Cortisol (morning) S 363.6 nmol/l 133 - 537 ECLIA
Cortisol (afternoon) S 324.6 nmol/l 68.20 - 327 ECLIA
PSA S 0.511 ng/ml 0.010 - 1.400 ECLIA
hemoglobin EB 153 g/l 140 - 180 SLS
hematocrit EB 0.44 l/l 0.40 - 0.53 calc
Total Cholesterol S 4.58 mmol/l 3.5 - 5.20 PHOT
HDL-Cholesterol S 1.38 mmol/l > 1.5 PHOT
LDL-Cholesterol S 2.92 mmol/l 0 - 3.35 PHOT
Glucose S 5.41 mmol/l 2.80 - 6.10 HK
AST S 17 IU/l 0 - 40 IFCC
ALT S 16 IU/l 0 - 41 IFCC
Magnesium S 0.76 mmol/l 0.66 - 1.07 PHOT
Iron S 18.02 µmol/l 7.20 - 27.70
Vitamin В12 S 416.9 pmol/l 145 - 569 ECLIA
25-OH-Vitamin D S 70 ng/ml 20-80/ opt. values >40 ECLIA

Seems my total T has dropped to 520 in the USA units. Free T and SHBG are not ready yet, but I do not expect surprises there. And I expect the total to go to 400s after a month or 2 where it normally revolves. What are my options when I cannot handle clomid? I guess HCG Mono or TRT. The thing is I WANT TO KEEP MY FERTILITY. I plan to try how I will feel on nolvadex, but I do not put much hope on that and I know it is not recommended for prolonged usage. I can also try restart protocol. The strange thing is my LH has increased, but total T dropped? Is it possible because I started metformin 10 days ago?

I do not have kids yet and I definetely want to have in the future, but Im not there yet. You know its not exactly something you do just because you thing time may be right.

I am arranging now consultation with one of the best hormone optimization doctors worldwide and I’m pretty sure he will advise my that optimizing my testosterone levels will make me feel much better. I guess he may also optimize my thyroid later.

What do you think about my optimization/fertility concern?

I believe that your thinking is too black and white. You’re looking for an exact formula to make everything all better, have the cake, eat it, and then live happily ever after. Sorry man. No formula exists for that in the real world.

First off, even if you were 100%, and your girl were 100%, and the stars were perfectly aligned…there’s STILL a chance that she would NOT get pregnant when you try. There is also still a chance that she WILL get pregnant while you are supposedly shut down and not even trying. Realize that and approach that subject as, when you are ready, do everything you can to tilt the odds in your favor and just go about your lives as usual. If / when it happens, it happens.

You have a few options for your particular concern, to help tilt the odds when you are ready. You can freeze sperm now (could be pricey), or you could add HCG when you are starting to try. TRT does not make you sterile for life. You can always wake the boys back up using HCG at a later time. No need to take HCG for the rest of your life trying to hold on to both sides of the coin. Start TRT and get optimized and give yourself the gift of a happy balanced life.

Get your TRT started and dialed in. Then when you want to try for kids, add in HCG until that happens and then drop it like a bad habit.

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I will freeze sperm for sure, here is not so costly. Its like 800-900 dollars for 5 years total. But with this asthenozoospermia I’m not sure what quality of sperm I’ll be freezing now.

I think it’s an unwarranted concern man. Doesn’t matter if you have 200 million or 200…only one of those little guys is gonna make it in the end.

I think people put too much emphasis on trying to get the best odds possible. Nothing wrong with that but odds are just that…odds. Nothing you can do will guarantee results. Go with what you’ve got and let life happen as it happens. If it happens just like you want it to…great. If it doesn’t, then you could always adopt in the future as well.

Bottom line…just do the best you can with what you’ve got brother.

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I guess you are right man.

Just I’m not very knowledgeable in the fertility situation and I feel it would be very selfish If I destroy my ability to have kids in order to feel better. It will be selfish to my partner, to my parents etc.

But I guess the fertility issue can be resolved. I will see also what the doctor will say, I’m very confident in his judgement have been following him for a few months.

And the other thing is my test levels are not like in the 200-300s like some other people starting TRT

I don’t think you will completely destroy your chances. Think about it like this…

How selfish would it be to get everything right, and then let your child grow up with an emotionally and hormonally unstable father, miserable and fatigued of life, because he doesn’t want to be selfish and “destroy” his chances of having the SECOND child that his wife so desperately wants?

I guess what I’m saying is that you need to fix you. Let the rest of life happen. The chips will fall where they may. When you spend too much effort trying to make EVERYTHING perfect, it can set you up for a much longer fall into despair and disappointment if things just don’t work out exactly the way you plan.

Deal with the problem that is in front of you now. Deal with the others as they come.

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There is always HCG and FSH injections added to a TRT protocol than can make the difference, worst case is you stop TRT and go on HCG and FSH injections for a short amount of time.

I know many people feel poor on HCG. Regarding how many drugs and even supplements I cannot handle I’m very positive I may be one of those people…I mean I’m very sensitive to all kinds of drugs and supplements

I’ve seen guys go through hell and back just to have children, hop on HCG, get the wife pregnant and get off quick.

I’m also super sensitive to medications and supplements, even caffeine gives my gitters.

I thought Im the only guy who feels strange on supplements and vitamins.

By the way next week I plan to inject only 3 times HCG 500 ui. The idea is to check what side effects I will experience. If its not bad I will discuss the idea of HCG mono with the doctor, but I know this doesnt work as a permanent solution :frowning: Im consulting him on 13th August when RT3 is ready(very long to get this done)

But 3 injections of 500 should not cause any shut down or decrease in LH prosuction, right?

As you like at my bloods how does it seem my minerals, iron and other stuff that the TRT can cause problems to?

Iron isn’t low by any standards, ferritin is the gold standard when looking at iron status. I would supplement magnesium as it’s closer to the bottom, I wouldn’t be surprised if TRT lowered it more when you step on the metabolic rates a little harder.

If I take more magnesium at night Im too sleepy the next day :frowning: No I take 150mg aspartate.

Ive ordered magnesium l-theonate and I will see how it will be with it

It is strange.

My free test is slightly more than previous time. Now it is 17ng/L and before it was 16ng/L. But total test has dropped since then and SHBG has increased. Very strange?! I guess albumin that I’ve never tested plays in that.

The other concern is I don’t know where I stand with this free T of 17ng/L. According to the scale that is 7-22 I’m in the top part. But this range WAS REDUCED, before it was 9-40!? They said it was due to the change in the testing method of free T from RIA ot EIA and the last one is showing lesser values. Unfortunately this is the only really trustworthy lab in my country that can measure free T. @systemlord what do you think about this? I would really like to know about these testing methods, but what I’ve read about that doesn’t answer whether EIA shows lesser values from RIA, they just say it is more precise.

So now I have some testosterone values that are a bit 50/50 whether TRT is needed or not and whether my low T symptoms(I’ve got all of them by the Jay Campbell’s book TOT Bible) are actually from sub-optimal T or something else. The thyroid is also not perfect, but not terrible.

I will see what doctor Nichols will say about all this on 13-th August. He is a very knowledgeable and “pro TRT” so to speak doctor so I completely trust his judgement.

What do you guys think, can someone with 17ng/L free test benefit from TRT or this level is too high to consider replacement?

If I had your T levels without TRT, I would be taking a hard look at my lifestyle and diet choices (which you may have already done?).

If I had those levels on TRT, I’d be looking at bumping my dose up just a tad. It’s not optimal levels, but it’s not bad for a natural production. I think you could maximize the benefits from the levels you have and postpone TRT until you have real issues.

Some things to consider and may want to change if they apply…

Do you use drugs (prescription or recreational)?

Do you drink alcohol?

Do you eat a balanced diet of around 40% protein / 30% carbs / 30% healthy fats?

Do you lift weights?

Are you active during the day or do you spend most of your time at a desk and then come home and watch tv?

Do you monitor blood glucose levels? If so what do they look like over the course of the day? Pre and post meal times?

Do you eat 3 large meals a day, or do you eat at least 6 small portions meals throughout the day?

Have you eliminated all external supplements as being possible causes of your issues?

Do you watch too much porn / masterbate too often?

Are you living with too much stress?

Do you do too much cardio?

You don’t have to answer these questions here. These are just a few things to ask yourself and give yourself honest answers. If you really dig deep I’m sure there some things you could probably stand to tweak in your life. Who knows, you may even find that there’s nothing wrong with you after all? Even if you’re not “optimal”, your levels are good enough that you should be able to have a pretty good quality of life. It’s possible that hormones are not the cause of your issues.

For what it’s worth…

Do you use drugs (prescription or recreational)? - No recreational drugs, no steroids. I was advised to take caber by Defy 3 months ago and Im taking it, very small dosages.

Do you drink alcohol? - Once-twice per week a glass of wine, some weeks no

Do you eat a balanced diet of around 40% protein / 30% carbs / 30% healthy fats? - I think I eat pretty balanced and healthy diet and Im close to those ranges

Do you lift weights? - Yes, now 3 times a week, last year 4

Are you active during the day or do you spend most of your time at a desk and then come home and watch tv? - I spend most of my time at desk unfortunately like the majority of us

Do you monitor blood glucose levels? If so what do they look like over the course of the day? Pre and post meal times? - I havent checked it during the day, but my fasting glucose seems a bit high(Glucose S 5.41 mmol/l 2.80 - 6.10). My insuline sensitivity is not great and I started metformin 2 weeks ago, but I continue to feel very sluggish and sleepy from it. Im not sure If I will be able to stick to it.

Do you eat 3 large meals a day, or do you eat at least 6 small portions meals throughout the day? - 3 large meals

Have you eliminated all external supplements as being possible causes of your issues? - I take magnesium, ashwagandha(a little bit) and I started metformin 2 weeks ago, some unpleasant side effects from it

Do you watch too much porn / masterbate too often? - I mastrubate or have sex like 2-3 times per night, no porn at all

Are you living with too much stress? - I do not have a lot of external stressors but I handle even the smallest stress with a lot of difficulty

Do you do too much cardio? - No, very little

Ye, so this is the situation

Wow. Did you mean to day 2-3 times per week???

Sorry, I was kidding and misplaced the posts.

But yes, 2-3 times per day. When I was in university some days I could go 5-6 times with my GF so my libido was always great, but now is much worse than before.

Even I experience libido symptoms, they are the smallest symptoms I experience. All other low T symptoms are extremely stronger.

Wow. Maybe you aren’t saying you have a libido problem, but 2-3 times a day is not an issue even if you used to 5-6 times a day.